| Objective: To provide new evidence for new chemotherapy treatment and improving prognosis, ninety Non-Hodgkin lymphoma(NHL) children patients was reviewed and followed up. The patients was divided to 2 groups according to the difference of chemotherapy adopted based on the pathological results. The influence of the two chemotherapy treatments on the prognosis was studied by analyzing the clinical characters and the risk factors.Methods: The patients, who were diagnosed as NHL based on pathological results from January 2004 to January 2013 in The Forth Hospital of Hebei Medical University, was reviewed and followed up, 90 cases were involved in the present study finally. According to the pathological results include T-NHL, B-NHL and LBL. The patients were divided to NHL-2004 group and NHL-2010 group according to the chemotherapy strategy. The influence of gender, stage, LDH, invasion of the marrow and/or central nervous system and combined with Rituximab or not on survival were analyzed.Univariate analysis and multivariate logistic regression analysis were adopted to analyze the influence of the factors on the survival of NHL: The statistical analyses were performed using SPSS software(version 21.0). Differences among variables were assessed by χ2 test. Linear regressions were tested by using the Spearman rank correlation. The Kaplan–Meier method was used to estimate survival, and the survival difference was compared using the Log-rank test. P<0.05 was considered to be statistically significant.Results: 1 Clinical data Ninety patients were involved in the present study, including 62(68.9%) male patients and 28(31.1%) female patients(ratio: 2.2:1). The age was ranged from 1.3 to 15.4 years old. The median age was eight. 1.2 Pathological results and site 1.2.1 Pathological results:①the precursor of B,T cell origin: the total was 17 cases, including of B-LBL 5 cases(5.6%), T-LBL 12 cases(13.3%). ②The source of mature B cell : the total of B-NHL was 43 cases, including of BL 25 cases(27.8%), DLBCL 9 cases(10%), the B large cell type 5 cases(5.63%), primary mediasti-nal large B cell lymphoma only 1case, and only 3 cases diagnosed as B-NHL and failed to further typing. ③The source of mature T cell and NK cell origin: The total was 30 cases. The T-NHL pathology report part was only T-NHL without further typing before the 2008 year, there were 18 cases pathological classification since 2009 year. The ALCL was 10 cases(11.1%), and PTCL was 3 cases(3.3%), and the T arge cell type was 3 cases(3.3%), and the NK/T cell lymphoma and SPTCL was 1 cases(1.1%), respectively.1.2.2 The primary sites The most common sites of LBL was superficial lymph nodes(12.2%, 11/90). And the mediastinal was 5 cases(5.6%, 5/90), the sternoclavicular joint was 1 cases(1.1%). The the most common primary sites was the head and neck tumor or the lymph node in the B- NHL(21.2%, 19/90). And the byabdominal/retroperitoneal lymph node or abdominal cavity organ was the second sites(17.8%, 16/90). From the tonsillar was 4 cases(4.4%, 4/90), and from the arotid gland was 2 cases(2.2%, 2/90), and from thymus and skin was 1 cases(1.1%, 1/90), respectively. The most common site of the T-NHL was the primary mediastinal / thymus(16.7%, 15/90).The head and neck lymph node was 11 cases(12.2%, 11/90), 2 cases was chest wall(2.2%, 2/90), the nasal cavity and skin was 1 case(1.1%, 1/90) respectively.1.3 Clinical stage Based on the St.Jude Stage system, the 90 patients include 26 stage Ⅲ cases(28.9%), 61 stage Ⅳ cases(67.8%)and 3 stage leukemia cases(3.3%). 2 Prognosis2.1 Progression/Recurrence Three patients were not relieved and died finally, including 1 B-NHL case, 1 T-NHL case and 1 LBL case, respectively. In the 7 cases of B-NHL patients, 5 patients recurred in the B-2004 group and 2 in the B-2010 group, the median recurrence time was 6.1 months(ranging from 5.0-14.0 months); in the 10 cases of T-NHL patients, 7 patients recurred in the T-2004 group and 3 patients in the T-2010 group, the median recurrence time was 9.2 months(ranging from 2.1-22.0 months). Only 3 patients was disease-free survived on 31 January, 2015,including of 1 cases T-LBL and 2 cases B-NHL.2.2 Giving up therapy The chometherapy was abandoned in 6 cases(stage Ⅳ), who were not involved in the study. CR were achieved in 4 cases and not in 2 cases. The giving up rate was 10.0%(10/100) if the 4 giving up therapy patients were concluded.2.3 Death related to therapy Tumour lysis syndrome occurred in 5 patients and 2 patients died; sepsis occurred in 10 patients and 2 patients died; lung infection was found in 3 patients, among whom respiratory failure was diagnosed in 1 patient and died finally. The death related to therapy was 5.6%(5/90).Lost follow up occurred in 8 patients after chemotherapy with a mean follow up period of 17.4 months(ranging from 3.0 to 54.4 months).3 Survival rate 3.1 Median survival time The overall median survival time was 44.5 months in the 90 patients, ranging from 2.1 to 130.7 months. The median survival time for the B-NHL patients, T-NHL patients and LBL patients were 55.8 months(ranging from 4.0 to 130.7 months), 43.4 months(ranging from 3.0 to 102.4 months) and 44.5 months(ranging from 5.3 to 61.2 months), respectively.3.2 Disease-free survival The overall 5 year EFS was(68.7±5.3)%. The 5 year EFS in B-NHL group, T-NHL group and LBL group were(74.2±8.3)%[(67.6±15.1)% for B-2004 group and( 81.6±8.1) % for B-2010 group ],( 58.6±11.0) % [(53.5±13.1)% for T-2004 group and(68.8±11.6)% for T-2010 group] and(87.4±8.4)%[100% for B-LBL group and(72.4±10.2)% for T-LBL group], respectively.3.3 Univariate analysis of 5 year EFS The pathological results(χ2=6.042,P=0.049), LDH<2N(χ2=4.171, P=0.041) and clinical stage Ⅲ(χ2=4.201, P=0.040) are revealed as statistically significant positive factors for patients 5 years EFS in univariate analysis. Whereas, gender(P=0.392), marrow invasion(P=0.091) and central nervous system invasion(P=0.709) have no statically significant influence on patients 5 year EFS.Furthermore, the pathological results(P=0.011) and LDH level(P=0.006) were recognized as independent risk factors of survival rate. 4 Results of the two chemotherapy treatmentThe 34 patients(18 B-NHL cases, 13 T-NHL cases and 3 T-LBL cases) who admitted to hospital between 2004 and 2009 were treated with the NHL-2004 strategy, and the 56 patients(25 B-NHL cases, 17 T-NHL cases and 9 T-LBL cases) admitted after 2009 were performed with the NHL-2010 strategy. The results showed that the two kinds of chemotherapy treatments had no difference on B-NHL and T-NHL patient’s survival rates(χ2=0.126 and 2.050,P>0.05).5 Combined with targeted therapy Rituximab combined chemotherapy treatment was carried out in 10 patients of the 25 B-NHL patients treated with NHL-2010 strategy, whose 5 year EFS was(92.9±6.9) %. The 5 year EFS for the other 15 patients was(60.0±15.5) %. The results revealed that combining with Rituximab could improve patient survival rate significantly(χ2=4.442, P=0.035).Conclusion: The disease-free survival has no difference between NHL-2004 and NHLL-2010 chemotherapy treatments. The clinical stage, differentiation and LDH are statically significant factors on patients’ survival. Morever, the pathological differentiation and LDH are independent risk factors. And the chemotherapy treatment combined with Rituximab are superior for the B-NHL patients than without it. |
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